Selecting the Right Online Appointment Scheduling Tools for Pediatrics

The patient access team at Nicklaus Children’s Health System knew it would have a lot of needs as it shopped around for a digital self-scheduling option. The Miami-based hospital system serves a pediatric population, 60 percent of whom are on Medicaid, so the team knew there’d be some complexities in selecting a health IT vendor.

But according to Leigh Bouskila, manager of patient access at Nicklaus Children’s Pediatric Specialists (NCPS), the physician group arm of the health system, those complexities were met with a self-scheduling tool from Kyruus Healthcare. The technology, plus a phased-in approach, has NCPS set up for success as it works to fortify its call center.

“When you call in to make an appointment, there are chances and days where it's contingent on staffing and tech issues,” Bouskila told PatientEngagementHIT in an interview. “So, if you call in on a day that it's super busy, like a Monday morning, patients are waiting a long time. We did a lot of work to see how we can optimize the call center. There was a review of our staffing, and then we also looked at the hours that you're able to call in to schedule an appointment.”

Those insights gave Bouskila and her team some ability to augment their call center workflows, but as many other health systems are starting to find, that wasn’t going to be enough.

Online options for appointment self-scheduling are becoming a must-have for healthcare providers, with October 2023 data showing that 80 percent of patients want this functionality. Bouskila and her team surmised the same when looking at their own operations.

“At the end of the day, what we were finding was that we could improve all of the hours, but we're still relying on technology,” she explained. “We're finding that patients are still calling in, but they're waiting a long time. And when they do get someone on the line, sometimes patients are not scheduled the right way because either they're getting the wrong diagnosis for the wrong clinician or they're a new patient when they really should be established.”

“Our call center works for 80 percent of cases, but we wanted to think more creatively about how we can serve these patients outside of those business hours, outside of those extended hours, and without having to call someone,” Bouskila added.

Still, NCPS knew implementing appointment self-scheduling wouldn’t be simple, and they needed to pick the right tool to make sure it was workable for the patient access team, clinicians, and patients themselves.

Studies have shown that’s a tough thread to needle. In 2022, patients said their online appointment scheduling options were falling short of their expectations, with 70 percent saying they’re still referred to telephone even when they seek digital, self-service options. For 61 percent of patients, poor online booking software actually dissuaded care access.

NCPS didn’t want to fall into any of those traps, so Bouskila said her team thought creatively about what the physician’s group would need in a tool.

Foremost, of course, was the need for multiple language options.

“We've done a really good job of investing in our people such that the employee workforce at Nicholas Children's really reflects the community,” Bouskila pointed out. “All of our scheduling associates are bilingual. Most of our staff in the offices actually checking in patients and seeing patients are bilingual. And we've done a lot of work to invest in tools to implement language interpreters at our clinics and through telehealth.”

“If we were going to implement a platform online that does allow you to schedule an appointment, it needed to be useful for all of the patients that we serve,” she said, reiterating that 60 percent of the patient population is insured by Medicaid and there are several language preferences at NCPS, including Spanish and Creole.

The system needs to be useable for more than just patients, though. As with any health IT purchase, there were technical considerations Bouskila and her team needed to make.

“Number one, interoperability. We needed something that spoke to our EMR,” she said, noting that Nicklaus uses an Oracle/Cerner EHR.

“Prior to implementing the online scheduling, we had this online appointment request. You would submit a form just like many health systems have,” Bouskila explained. “You’d put in your information, but one, it wouldn’t speak in real-time to Cerner, so you could never pick the exact date and time you wanted. And then two, our staff would have to look at the response from the online request, go into Cerner and do the full scheduling process. It was a very manual-intensive effort.”

NCPS selected a system that would integrate directly into its EHR, eliminating the need for extra administrative work translating online requests into EHR input.

What’s more, the health system needed a tool that could handle the complexities of the population it serves. The patients visiting Nicklaus are, in some cases, socially complex, Bouskila pointed out, but there are also a lot of nuances to engaging a pediatric population.

“It's also really important that the platform has worked with pediatrics, especially with the population that we serve with the Medicaids versus the commercial plans versus the who's the parent or guardian versus the kid,” she said.

“We had to make sure that we could build the platform to make sure that the right person is scheduling the visit and they're scheduling and registering in a way that we could take the correct payer information, do the pre-work, and not have to call them prior to them coming in.”

Once they settled on a product, Bouskila and her team needed to determine the best rollout plan, knowing that when introducing a new technology, there could be implementation bumps and issues getting end-users on board. To that end, they chose a more phased-in approach, she said.

“It's a game changer if you adopt it the right way and do the due diligence,” Bouskila asserted. “This project did take some more time than we expected, but it was worth the investment.”

Starting in October 2023, Nicklaus started using Kyruus Healthcare’s provider search feature, which introduced patients and families to parts of the new system. In January 2024, the health system rolled out the self-scheduling technology at five specialty offices.

That slow rollout helped Nicklaus clock some early wins while identifying problem areas that are going to require further consideration, Bouskila pointed out.

“The phased-in approach also helped with adoption,” she added. “In the beginning, we had a lot of pushback from our physicians concerned over losing control over their schedules.”

“And with the go-live, we've actually had physicians see patients who were online-booked but did not know that they were online-booked. And that was a pretty big win, and that helped spread the news to the other physicians who are much less hesitant to roll out their respective practices now.”

In the coming months, Bouskila said the patient access team will keep an eye on key performance metrics, like new patients seen within a week and other metrics linked to all appointments seen: no-show rates, cancelations, and reschedules, in particular.

She also predicted that the tool will have even stronger use cases as Nicklaus implements it across more care sites, including ones treating more complex patients.

“When you think about the continuum of care, online scheduling for appointments that are simpler is a great tool to make things quicker for the family and easier,” she concluded. “But when I think about where we can go and where the real need is, it’s those complex patients that need multiple services on the same day or have multiple siblings that need to be addressed or have some sort of diagnostic service that needs to come with that.”